title: Early changes in functional dynamic magnetic resonance imaging predict for pathologic response to neoadjuvant chemotherapy in primary breast cancer.
abstract: OBJECTIVE
  Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows noninvasive, in vivo measurements of tissue microvessel perfusion and permeability. We examined whether DCE-MRI done after two cycles of neoadjuvant chemotherapy could predict final clinical and pathologic response in primary breast cancers.
  
  
  METHODS
  Thirty-seven patients with primary breast cancer, due to receive six cycles of neoadjuvant 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy, were examined using DCE-MRI before neoadjuvant chemotherapy and after two cycles of treatment. Changes in DCE-MRI kinetic parameters (K(trans), k(ep), v(e), MaxGd, rBV, rBF, MTT) were correlated with the final clinical and pathologic response to neoadjuvant chemotherapy. Test-retest variability was used to determine individual patient response.
  
  
  RESULTS
  Twenty-eight patients were evaluable for response (19 clinical responders and 9 nonresponders; 11 pathologic responders and 17 nonresponders). Changes in the DCE-MRI kinetic parameters K(trans), k(ep), MaxGd, rBV, and rBF were significantly correlated with both final clinical and pathologic response (P < 0.01). Change in K(trans) was the best predictor of pathologic nonresponse (area under the receiver operating characteristic curve, 0.93; sensitivity, 94%; specificity, 82%), correctly identifying 94% of nonresponders and 73% of responders. Change in MRI-derived tumor size did not predict for pathologic response.
  
  
  CONCLUSIONS
  Changes in breast tumor microvessel functionality as depicted by DCE-MRI early on after starting anthracycline-based neoadjuvant chemotherapy can predict final clinical and pathologic response. The ability to identify nonresponders early may allow the selection of patients who may benefit from a therapy change.
authors.affiliation: Mount Vernon Hospital, Northwood, Middlesex, UK. meilinahsee@hotmail.com
authors.forename: Mei-Lin W
authors.initials: ML
authors.lastname: Ah-See
authors.forename: Andreas
authors.initials: A
authors.lastname: Makris
authors.forename: N Jane
authors.initials: NJ
authors.lastname: Taylor
authors.forename: Mark
authors.initials: M
authors.lastname: Harrison
authors.forename: Paul I
authors.initials: PI
authors.lastname: Richman
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Burcombe
authors.forename: J James
authors.initials: JJ
authors.lastname: Stirling
authors.forename: James A
authors.initials: JA
authors.lastname: d'Arcy
authors.forename: David J
authors.initials: DJ
authors.lastname: Collins
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pittam
authors.forename: Duraisamy
authors.initials: D
authors.lastname: Ravichandran
authors.forename: Anwar R
authors.initials: AR
authors.lastname: Padhani
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D003287:Contrast Media; D003520:Cyclophosphamide / Q000627:therapeutic use; D015251:Epirubicin / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D015251:Epirubicin; D003520:Cyclophosphamide; D019786:Gadolinium DTPA; D005472:Fluorouracil